Airway

CPAP for cardiogenic pulmonary edema

An alert patient with crackles, clammy skin, and cyanosis from left-sided heart failure is drowning in alveolar fluid. A metered-dose inhaler treats bronchospasm, not hydrostatic edema; a non-rebreather alone does not push fluid out of the alveoli.

Where protocol allows, continuous positive airway pressure (CPAP) lowers work of breathing and drives edema back into the capillaries. Reserve bag-valve-mask ventilation for patients who cannot protect their airway or no longer move adequate volume.